Every twelve minutes, someone in the United States takes their own life. Depression is one of the most common mental illnesses in the United States, affecting over three hundred million people worldwide. Approximately 15.7 million (6.7%) adults experience at least one major depressive episode. Many people have the misconception that depression is just a state of emotional distress. People with depression are not just sad. What many people don’t realize is that depression is a serious neurologic disorder that can have many serious consequences if left untreated. The burden of depression and other mental health conditions is on the rise globally. A World Health Assembly resolution passed in May 2013 has called for a comprehensive, coordinated response to mental disorders at country level. The World Health Organization states that in most serious cases “depression can lead to suicide. Close to 800,000 people die due to suicide every year.” So why do many people believe that depression is not an actual medical illness?
Depression is not just a short-lived emotional response to everyday challenges in life. It is long lasting and can range from minor to severe intensity (Depression, World Health Organization). It can seriously impair how one functions in the family, at work, at school etc. Sigmund Freud, the “Father of modern psychiatry, believed that depression could be traced to unresolved psychological problems buried in lower levels of consciousness” (Pat. Williams-Boyd), meaning that depression was not just a normal, and regular form and period of emotional-distress, rather an intense recurring mental ailment. Associate professor with the Bloomberg School's Department of Mental Health, Ramin J. Mojtabai, states “Depression over-diagnosis and over-treatment is common in the U.S., and frankly the numbers are staggering,”. In his study, he also found that most of the participants of the study did not meet the criteria of the twelve-month major-depressive-episodes. The participants who did not meet the criteria used fewer treatments, but many of the groups used prescribed medication. What are the qualifications you need to meet to fit the criteria of having a twelve-month major-depressive-episode? According to Priscilla Van Dyke and Jennifer Kelley, the Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5) show
DSM-5 Diagnostic Criteria for MDD
• Presence of symptoms
• Symptoms persist ≥ 2 weeks
• (Symptoms # 1 or 2 (or both) + ≥ 5 of 9 total symptoms
Depressed mood
Marked ↓ of interest or pleasure in activities
Weight ↓ or ↑
Insomnia or hypersomnia
Psychomotor agitation or retardation
Fatigue or ↓ of energy
Feelings of worthlessness or excessive guilt
↓ cognitive function or ↓ concentration
Suicidal ideation (SI)
If the person does not meet these criteria, then technically they do not fit the profile. The participants in Motjabi’s study were not meeting the criteria but were still being treated as if they did. This helps the argument that depression is over diagnosed. However, even the smallest form of depression can grow and lead to a more serious case and could possibly lead to more problems. Rates of diagnosis of depression have risen steeply in recent years. Gordon Parker believes this is because current criteria are medicalizing sadness, but Ian Hickie argues that many people are still missing out on lifesaving treatment. It is normal to feel depressed. In a group study of 242 teachers, the 1978 baseline questionnaire defined depression as “a significant lowering of mood, with or without feelings of guilt, hopelessness and helplessness, or a drop in one's self-esteem or self-regard.” Ninety five percent of the group reported such feelings, indicating the global nature of depressed mood states. Rates of diagnosis of depression have risen steeply in recent years. Gordon Parker believes this is because current criteria are medicalising sadness, but Ian Hickie argues that many people are still missing out on lifesaving treatment. It is normal to feel depressed. In a group study of 242 teachers, the 1978 baseline questionnaire defined depression as “a significant lowering of mood, with or without feelings of guilt, hopelessness and helplessness, or a drop in one's self-esteem or self-regard.” Ninety five percent of the group reported such feelings, indicating the global nature of depressed mood states.
Depression is a serious mental illness that has to do with the brain. It is not just a short feeling of sadness. According to MentalHealth.gov, the feeling of sadness “persist and interfere with everyday life.” There are also many different cases of depression including “genetic, environmental, psychological, and biochemical factors. Depression usually starts between the ages of 15 and 30 and is much more common in women.” (MentalHealth.gov). After giving birth, some women can even develop a form of depression known as postpartum depression. It is also “one part of bipolar disorder” and it can even be seasonal, mostly in the winter. (Mentalhealth.gov). So, what can someone with depression to get help? The most common way people get help is by going to a doctor and getting antidepressants and going to talk therapy. Most doctors recommend doing both. One of the most common antidepressants is called Prozac. Prozac was put on the market in 1986 and was “the first antidepressant medication in the selective serotonin reuptake inhibitor (SSRI) group.” (Geoffrey, “The Promise of Prozac”).When the first antidepressant, imipramine, was developed, manufacturer Geigy was reluctant to market it, thinking there was an insignificant amount of people who had depression. Now, depression is all around, and antidepressant drugs have a dominant share of the drug market. (Gordan Parker, Is Depression over diagnosed? Yes) “Roughly 27 million Americans took prescription antidepressants in 2005, making them the most commonly prescribed class of medications in America” (NPR).
There are different types of depression. Each having different symptoms and levels of severity. Recurrent depressive disorder involves multiple and repeated episodes. During such episodes, the person will have a loss of interest, reduced energy leading to diminished activity, and they will experience a depressed mood. It is common for someone with depression to also suffer from an anxiety disorder, lack of sleep and appetite, and may have feeling of worthlessness. There are three main categories of depressive episodes. Mild, moderate, or severe. In severe episodes, a person will be adamant on doing any activities, and have very limited energy. The other form of depression is known as bipolar affective disorder. This type of depression typically consists of both manic and depressive episodes separated by periods of normal mood. Manic episodes involve elevated or irritable mood, over-activity, pressure of speech, inflated self-esteem and a decreased need for sleep. Depression results from a complex interaction of social, psychological and biological factors. People who have gone through adverse life events (unemployment, bereavement, psychological trauma) are more likely to develop depression. Depression can, in turn, lead to more stress and dysfunction and worsen the affected person’s life situation and depression itself. There are interrelationships between depression and physical health. For example, cardiovascular disease can lead to depression and vice versa. Prevention programmes have been shown to reduce depression. Effective community approaches to prevent depression include school-based programmes to enhance a pattern of positive thinking in children and adolescents. Interventions for parents of children with behavioural problems may reduce parental depressive symptoms and improve outcomes for their children. Exercise programmes for the elderly can also be effective in depression prevention.
There are effective treatments for moderate and severe depression. Health-care providers may offer psychological treatments (such as behavioral activation, cognitive behavioral therapy [CBT], and interpersonal psychotherapy [IPT]) or antidepressant medication (such as selective serotonin reuptake inhibitors [SSRIs] and tricyclic antidepressants [TCAs]). Health-care providers should keep in mind the possible adverse effects associated with antidepressant medication, the ability to deliver either intervention (in terms of expertise, and/or treatment availability), and individual preferences. Different psychological treatment formats for consideration include individual and/or group face-to-face psychological treatments delivered by professionals and supervised lay therapists. Psychosocial treatments are also effective for mild depression. Antidepressants can be an effective form of treatment for moderate-severe depression but are not the first line of treatment for cases of mild depression. They should not be used for treating depression in children and are not the first line of treatment in adolescents, among whom they should be used with extra caution.
Depression occurs more often in women than men. Some differences in the manner in which the depressed mood manifests has been found based on sex and age. In men it manifests often as tiredness, irritability and anger. They may show more reckless behavior and abuse drugs and alcohol. They also tend to not recognize that they are depressed and fail to seek help. In women depression tends to manifest as sadness, worthlessness, and guilt. In younger children depression is more likely to manifest as school refusal, anxiety when separated from parents, and worry about parents dying. Depressed teenagers tend to be irritable, sulky, and get into trouble in school. They also frequently have co-morbid anxiety, eating disorders, or substance abuse. In older adults depression may manifest more subtly as they tend to be less likely to admit to feelings of sadness or grief and medical illnesses which are more common in this population also contributes or causes the depression. Depression and anxiety disorders are different, but people with depression often experience symptoms similar to those of an anxiety disorder, such as nervousness, irritability, and problems sleeping and concentrating. But each disorder has its own causes and its own emotional and behavioral symptoms. Many people who develop depression have a history of an anxiety disorder earlier in life. There is no evidence one disorder causes the other, but there is clear evidence that many people suffer from both disorders.
Depression is not something to brush off. It is a mental illness that should be taken seriously. The rates of depression worldwide continue to increase, and although the people stating that it is over diagnosed have valid reasoning, such as not fitting the criteria for twelve-month depressive episodes, it does not change what depression is, or the diagnostic.